Proximal femur fractures: incidence before and during the COVID-19 pandemic

Abstract

Background: Fracture of the proximal femur is a common and important cause of mortality and functional loss. The incidence of this type of fracture increases with age, mainly due to the increase in the number of falls associated with a higher prevalence of osteoporosis. It is more commonly related to elderly people living in urban areas, female and institutionalized. Fracture of the proximal femur can be intracapsular or extracapsular. In the first type are femoral neck fractures, and in the second, transtrochanteric fractures, both of which result from low-energy trauma, such as falls. The treatment of most of these fractures is surgical, aiming at the reduction and stable fixation of the fracture, using the most varied methods of osteosynthesis or arthroplasty, especially in the case of fractures of the femoral neck with displacement.

Aim: To assess the incidence of proximal femur fractures before and during the COVID-19 pandemic.

Method: This is a retrospective study, with a systematic review of data regarding the number of surgical procedures for proximal femur fractures in the years 2019 to 2021, corresponding to the period before and during the COVID19 pandemic, and to demonstrate its incidence and need of care, in a private hospital in the interior of the state of São Paulo.

Results: During the study period, 1,203 procedures were performed. It was possible to notice the gradual increase in cases during the pandemic years, and a high rate of proximal femur fractures in women, reaching a difference of 62% in relation to men in 2022. The mortality rate during hospitalization was 2.39% in 2019, 2.78% in 2021, and 2.83% in 2022. The factors positively correlated with mortality, most frequently indicated, were advanced age, presence of associated diseases, significant cognitive impairment and female gender.

Conclusion: Recent literature, even within the context of a pandemic and its restrictions, has identified four major factors directly related to mortality in proximal femur fractures in the elderly, namely the patient's advanced age, the presence of associated diseases, the female sex and the existence of cognitive deficiencies.